NeuroAnatomy Frazier Rehab Institute - PowerPoint Presentation

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NeuroAnatomy

Frazier Rehab Institute

Spinal Cord Medicine Program

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Brain and Spinal Cord

The

brain is protected by our skulls.

The spinal cord is protected by the vertebral column.Most common areas of injuries are at C6-7 and T12-L1. This is because the spinal cord is slightly larger at those levels.

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The Nervous System

Central

Nerves:

Your brain and your spinal cord.Cranial nerves: (KRAY-nee -ul) Nerves that go from Brain to Ears, Nose, Eyes, Mouth and other parts of your face.

Peripheral

Nerves:

(Pur-RIF-ur-al) Nerves that go from your spinal cord out to your arms and legs.Autonomic Nerves: (Aw-to-NOM-ik) Nerves that go from your spinal cord to your organs (lungs, heart, intestines, bladder and sex organs.

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Cervical Spine

The

first 7 bones of the vertebral column are referred to as the Cervical spine. Abbreviated C.

The first 2 are referred to as the Atlas and Axis.The vertebral bones in the cervical spine are much smaller in size compared to the rest of the spine.There are 8 nerves in the cervical spine. C1-C8. C3-5 are responsible for innervating the diaphragm. The other nerves are responsible for innervating the skin and muscles in your arms.

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Side by Side Comparison

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Cervical Spine x-ray showing

plate and screws

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Cervical fixation with cage

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Thoracic Spine

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Thoracic Spine

There

are 12 vertebral bones in the

the Thoracic area. Your ribs attach to these vertebrae. The nerves in this area will innervate the skin on your trunk.They are responsible for your rib muscles, abdominal muscles and your back extensor muscles.

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Thoracic MRI

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Lumbar Spine

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Lumbar Spine

The

Lumbar section includes 5 vertebrae and nerves.

The lumbar nerves are going to innervate the muscles and skin in the front of the legs.

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Sacral Spine

The

last section of the spinal cord is the Sacral section. The sacrum is made of 5 bones that are fused together.

The sacral nerves innervate the feet and hamstrings as well as our bowel and bladder function.

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Review of AnatomyCervical Spine

Thoracic

Spine

Lumbar SpineSacral Spine

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Review of Spinal Column

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Review of Spinal Cord Levels

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ASIA Form

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ASIA Classification

ASIA

A –Complete injury, no sensation at the lowest level of sensation S4-5

ASIA B –Incomplete injury, sensation at the lowest level of sensation S4-5ASIA C –Incomplete injury, sensation at the lowest level of sensation S4-5 and muscle strength of grade 3 or less in half the muscles below the level of injuryASIA D-Incomplete injury, sensation at the lowest level of sensation S4-5 and muscle strength of grade 3 or greater in half the muscles below the level of injury

.

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Fracture vs. Neurological Level

X

rays tell us where fractures are

located - in the cervical, thoracic or lumbar region. The location of the fracture does

not always correspond to the neurologic damage.

The

ASIA Impairment Scale provides the neurologic level of an injury.Sensation is graded on a 3 point scale:0 no feeling

1

impaired feeling

2

full

sensation

When

assessing the neurological

level,

we look for the last level of consecutive 2’s or full sensation.

Areas

below may have 2’s but the last consecutive 2 is the neurological level.

A fracture

may be at

C6,

but

neurological

level may be

C8

.

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Spinal Cord

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Central Cord Syndrome

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Brown Sequard Syndrome

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NeuroplasticitySpinal

cord is able to relearn after injury

Rehab

is about re-educating the body to move againCrucial factors to promote successful neuroplasticityIntensive

practice, practice, practice

Demand

MotivationCertain level of stress is necessaryAttentional componentTask SpecificActive vs. passive

Role

of feedback

Decrease

level of

fatigue